Active NPI
Dalton Krencik, OTD, OTR/L
- Occupational Therapist
- Fort Pierce, FL
National Provider Identifier
1083369722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT22788
- Practice address
- 4715 Kirby Loop Rd
Fort Pierce, FL 34981-5345 - Phone
- (772) 577-6964
- Fax
- (772) 461-9954
- NPI assigned
- Feb 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT22788 | FL | Primary |
Addresses
Primary practice location
4715 Kirby Loop Rd
Fort Pierce, FL 34981-5345
Mailing address
1702 Mariner Bay Blvd
Fort Pierce, FL 34949-3613
Phone (772) 577-6964
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT22788 | Other | FL | FLORIDA DEPARTMENT OF HEALTH STATE LICENSE NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Unknown |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT22788 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace Therapies, LLC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645401600000",
"number": "1083369722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 MARINER BAY BLVD",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349493613",
"telephone_number": "772-577-6964",
"fax_number": "772-461-9954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4715 KIRBY LOOP RD",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349815345",
"telephone_number": "772-577-6964",
"fax_number": "772-461-9954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRENCIK",
"first_name": "DALTON",
"name_prefix": "Dr.",
"credential": "OTD, OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-21",
"last_updated": "2022-02-21",
"certification_date": "2022-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT22788",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA DEPARTMENT OF HEALTH STATE LICENSE NUMBER",
"identifier": "OT22788",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Unknown",
"affiliation": "N",
"address_1": "4715 Kirby Loop Rd",
"city": "Fort Pierce",
"state": "FL",
"country_code": "US",
"postal_code": "349815345",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Pierce, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.